Download Osteoarthritis

Osteoarthritis
Background:

Osteoarthritis, the most common type of joint
disease, is a heterogeneous group of
conditions resulting in common histopathologic
and radiologic changes. It is a Degenerative
Disorder resulting from the biochemical
breakdown of articular cartilage in the synovial
joints. Although osteoarthritis is thought to be
largely due to excessive wear and tear,
secondary nonspecific inflammatory changes
may also affect the joints.
Mortality/Morbidity:

Osteoarthritis typically develops slowly and
progresses over several years. Usually, the
pain slowly worsens over time, but it may
stabilize in some patients. Osteoarthritis of
the knee is a leading cause of disability in
elderly persons. Osteoarthritis also causes
millions of Americans to miss work
because of back pain.
Race:
Primary osteoarthritis affects all races,
although the prevalence and patterns of
the disease appear to differ.
 The disorder is more prevalent in Native
Americans than in the general population.
 In persons older than 65 years,
osteoarthritis is more common in whites
than in blacks.

Sex: In individuals older than 55 years,
the prevalence of osteoarthritis is higher
among women than men.
 Age: Osteoarthritis occurrence appears to
increase with patient age, in a nonlinear
fashion

Signs and symptoms
Primary osteoarthritis is a common disorder of the
elderly, and patients are often asymptomatic. Patients
with symptoms usually do not notice them until after
they are aged 50 years.
 Deep, achy, joint pain exacerbated by extensive use is
the primary symptom. Also, reduced range of motion
and crepitus are frequently present. Joint malalignment
may be visible. Heberden nodes, which represent
palpable osteophytes in the distal interphalangeal joints,
are characteristic in women but not men. Inflammatory
changes are typically absent or at least not pronounced.

Physical:

Early in the disease process, physical examination
findings include the following:
– Joints may appear normal.
– Gait may be antalgic if weight-bearing joints are involved.

Later in the disease process, physical examination
findings include the following:
–
–
–
–
–
Visible osteophytes may be noted.
Joints may be warm to palpation.
Palpable osteophytes frequently are noted.
Joint effusion frequently is evidenced in superficial joints.
Range-of-motion limitations, because of bony restrictions and/or
soft tissue contractures, are characteristic.
– Crepitus with range of motion is not uncommon.
Causes:
Primary OA, which can be either localized or
generalized, is most often idiopathic, except in
rare cases where a defective gene has been
found to cause a familial form of OA.
 Secondary OA can be caused by the following:

– Obesity (increases mechanical stress)
– Repetitive use (ie, jobs requiring heavy labor and
bending)
– Previous trauma (ie, posttraumatic OA)
– Infection
– Crystal deposition
– Acromegaly
– Previous rheumatoid arthritis (ie, burnt-out
rheumatoid arthritis)
– Heritable metabolic causes (eg, alkaptonuria,
hemochromatosis, Wilson disease)
– Hemoglobinopathies (eg, sickle cell disease,
thalassemia)
– Neuropathic disorder leading to a Charcot joint (eg,
syringomyelia, tabes dorsalis, diabetes)
– Underlying orthopedic disorders (eg, congenital hip
dislocation, slipped femoral capital epiphysis)
– Disorders of bone (eg, Paget disease, avascular
necrosis)
Lab Studies:
Researchers have looked at monoclonal
antibodies, synovial fluid markers, and
urinary pyridinium cross-links (ie,
breakdown products of cartilage).
 (ESR) is not usually elevated, but it may
be slightly elevated in cases of erosive
inflammatory arthritis.

Imaging Studies:

Plain radiographs
– Joint space narrowing
– Osteophytes
– Subchondral sclerosis
– Subchondral cysts

MRI
Treatment
To effectively manage the condition
 Exercise regularly. Exercise can strengthen
muscles, increase range of motion, improve
balance and help reduce stress. Good exercises
include walking, stationary bicycle riding, water
exercises
 Control weight. Excess body weight adds
stress on joints in back, hips, knees and feet 

Eat a healthy diet.
Eating a diet high in
vegetables, whole
grains and fruits helps
maintain a proper
weight and good
health.
Treatment


There's no known cure for osteoarthritis,
but treatments can help to reduce pain
and maintain joint movement.
treatments may include medication,
self-care, physical therapy
 and occupational therapy.
 In some cases, surgical may be
necessary.


Topical pain relievers. Over-the-counter
creams, gels, ointments and sprays can
temporarily relieve arthritis pain and
reduce inflammation in joints close to the
surface of the skin, such as fingers, knees
and elbows. Topical pain relievers include
trolamine salicylate , methyl salicylate,
menthol and camphor, Eucalyptamint, or
capsaicin from the seeds of hot chili
peppers.
Nonsteroidal anti-inflammatory
drugs (NSAIDs). These both relieve pain
and reduce inflammation. NSAIDs range
from aspirin, ibuprofen , ketoprofen , and
naproxen sodium.
 Corticosteroids Intra –Articular can relieve
some pain for four to six months.
 Joint replacement

Neutripharmaceticals
(( Chondroprotectives ))
Glucosamine
 Chondroitin Sulfate
 Omega 3
 Vit. D + Cal.
